From: Secretary of Health, Niger

Anna Fuselier
Nutrition in Niger

From: Secretary of Health, Niger

To: Minister of Finance, Niger

Introduction

Nutritional issues are approaching a state of emergency. Undernourishment now affects 29% of the Nigerien population[i]. Iron and Vitamin A deficiencies are rampant, affecting about 40% and 50% of the population, respectively[ii]. Undernourishment affects most seriously the rural poor and children under five. It stems from food shortages, poor feeding practices, lack of education, and lack of health coverage. Undernourishment causes stunting, lowers economic productivity and intellectual capability, and increases susceptibility to illness. Immediate cost effective solutions are to increase distribution of micronutrient supplements and fortification of foods and create programs that promote exclusive breastfeeding. In the long term, we must expand education, particularly for women.

Nature and Magnitude of the Problem

In regards to nutrition, Niger is in one of the worst off states in the world. 29% of the Nigerien population is undernourished, and 15% is acutely malnourished[iii]. Niger has the greatest rate of stunting in the world[iv]. Half of all children under the age of five are stunted, and this number is increasing at a rate of 1% per year[v]. About 26,000 children die every year in Niger, largely from undernourishment related illnesses and deficiencies[vi].
Micronutrient deficiency due to a lack of dietary diversity is one of the greatest contributing factors to Niger’s undernourishment problems. Over 40% of the population is Vitamin A deficient[vii]. Additionally, 47% of women of child bearing age and 57% of children under five are anemic[viii]. Micronutrients are essential for proper child growth and for the body to remain properly nourished as an adult.

Affected Populations
The most seriously at risk groups include the rural poor and children under five due to poverty, poor feeding practices, and lack of access to health care. Children in Niger have a 20% chance of death before their fifth birthday, largely due to undernourishment and its complications[ix]. Because exclusive breastfeeding is virtually unheard of in Niger, more than 75% of infants are subject to poor feeding techniques[x]. This leads to poor initial growth and a loss of appetite, which creates a likelihood of undernourishment and stunting early in life[xi]. This is due to a lack of education of women of child bearing age. The damage done in these years is irreversible.

Risk Factors

Poor rural and agricultural populations are at a heightened risk for undernourishment. 29% of children in urban communities suffer from undernourishment compared to 43% in rural communities[xii]. Despite the large agricultural population (82%), only 12% of Niger’s land is arable, and food shortages in agricultural communities are extremely common[xiii]. Even when food is in supply, the diet of rural communities is based on cereals, and foods rich in micronutrients are largely unavailable due to chronic poverty and poor distribution[xiv].
Poor rural communities are further at risk due to minimal access to effective health care or nutrition programs[xv]. Only 48% of the population has access to any health care at all (mostly urban based), and as little as 30% of children are covered by feeding and rationing programs[xvi]. Additionally, when food blends do reach the children, they are low in micronutrients and minimally effective at averting undernourishment[xvii]. Compounding this problem is the fact that most members of the population do not seek health care because they are not aware it exists, do not understand how it can help, or do not have the ability to pay for it[xviii]. This stems from the chronic poverty and lack of education in Niger. School enrollment is under 40% and only 30% of the population is literate[xix]. Those who are literate or educated are mostly urban men, while rural women are the primary caregivers of children and seekers of health care in rural areas[xx]. This leads to an increased risk of rural peoples to undernourishment.

Economic and Social Consequences

Leaving these issues unaddressed would be catastrophic to Nigerien society. Child undernourishment and stunting causes irreparable physical and mental damage. Lack of proper nourishment during pregnancy contributes to the impairment at birth of 130,000 children per year[xxi]. The percentage of stunted children in Niger increases yearly, and each stunted child is less likely to reach their full intellectual potential and therefore less likely to complete school. Because uneducated and stunted mothers are more likely to raise malnourished and stunted children, this perpetuates the trend of malnourishment, illiteracy, and lack of education. This means that the Nigerien population is less physically and mentally capable of being productive. Consequently, mental and physical defects related to undernourishment and micronutrient deficiencies cause a loss of 1.7% of GDP every year, further contributing to economic problems and chronic poverty[xxii].

Priority Action Steps
Systems already exist that attempt to tackle undernourishment in the short term, but they must be reformed and improved if we are to see significant results. The processes of fortifying salt for distribution and making Vitamin A supplements widely available to children have already begun, but they must be supported and escalated. It is necessary to add outreach and distribution programs to rural regions with specific efforts to provide supplements to children under five and pregnant women[xxiii]. The same must be done for food distribution and rationing programs that often do not reach the rural areas that are in need of it most. Because the people are unlikely to seek it out themselves, especially in regions where they have never had access to programs or health care before, the programs must initially go directly to the people
It is also essential in the short term to create and expand a program to educate mothers about exclusive breastfeeding and proper nourishment of infants. A lack of education about the consequences of poor feeding practices is a leading contributor to stunting and early life malnourishment. A large portion of these DALYs and deaths due to undernourishment could be averted through simple outreach programs that promote exclusive breastfeeding. Such programs should be concentrated in rural areas, since the majority of illiteracy and undernourishment are found here.
In the long term, the most cost effective solution to undernourishment is investment in education. If education is improved and expanded, then the number of children completing school will increase and more adults will be educated and literate. This will make the general population more equipped to understand the causes of and solutions to undernourishment and raise healthier, more educated, and more productive children. This investment will therefore eventually create a more stable and successful society, both economically and socially, which will contribute to the reduction of undernourishment.
Few countries in the world are worse off in regards to nutrition than Niger. The population is suffering greatly and to an extent, needlessly. With a few simple cost effective measures, we can drastically improve the wellbeing of the Nigerien population and set the country on a healthier and more productive path.

[i]Agriculture and Consumer Protection Department, ."Nutrition in Niger Summary."FAO.N.p., n.d. Web. 22 Mar 2012. <

[ii]Agriculture and Consumer Protection Department, ."Urban Nutrition."FAO.N.p., n.d. Web. 22 Mar 2012. <

[iii] Agriculture and Consumer Protection Department, .“Nutrition in Niger Summary.”

[iv]Agriculture and Consumer Protection Department, ."Urban Nutrition."

[v]Agriculture and Consumer Protection Department, ."Nutrition in Niger Summary."

[vi]Agriculture and Consumer Protection Department, ."Urban Nutrition."

[vii]Agriculture and Consumer Protection Department, ."Urban Nutrition."

[viii]Agriculture and Consumer Protection Department, ."Urban Nutrition."

[ix]Save the Children, ."Nutrition Report 2012."Save the Children. N.p., n.d. Web. 22 Mar 2012. < LIFE FREE FROM HUNGER - TACKLING CHILD MALNUTRITION.PDF>.

[x]USAID, ."Understanding Nutrition and the causes of malnourishment in Niger."FEWS.N.p., n.d. Web. 22 Mar 2012. <

[xi]Save the Children

[xii]World Vision, . "Niger." World Vision.N.p., n.d. Web. 22 Mar 2012. <

[xiii] World Vision

[xiv]Agriculture and Consumer Protection Department, ."Nutrition in Niger Summary."

[xv]Agriculture and Consumer Protection Department, ."Nutrition in Niger Summary."

[xvi] USAID

[xvii] USAID

[xviii] USAID

[xix] World Vision

[xx] World Vision

[xxi]Agriculture and Consumer Protection Department, ."Urban Nutrition."

[xxii]Agriculture and Consumer Protection Department, ."Urban Nutrition."

[xxiii] World Vision